=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467123851
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KERRI ANN CAMPBELL MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2021
-----------------------------------------------------
Last Update Date | 10/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2501 W HILLSBORO BLVD STE 107
-----------------------------------------------------
City | DEERFIELD BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33442-8437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-433-2405
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7737 NW 79TH AVE APT 206
-----------------------------------------------------
City | TAMARAC
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33321-2851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH23370
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------